HENRY SMITH
Dependent on policy B03M000143
Claims
2
Attributed to this person
Charged
551.00
Total submitted
Denied
142.77
1 denied claims
Patient responsibility
0.00
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | HENRY SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000143 |
| Date of birth | 21 Jan 1995 |
| Plan | BRONZE EPO |
| Covered from | 11 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000589 | 18 Jul 2026 | 418.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 142.77 |
| CLM0000588 | 2 May 2026 | 133.00 | NORTHSTAR MUTUAL | Not denied | — |